Bowel habits and functional bowel disorders in Sri Lankan adults: A cross-sectional study.

BACKGROUND: Definitions of normal bowel habits vary across populations and are influenced by diet, lifestyle and cultural factors. Sri Lanka lacks population-level data describing normative bowel habits and the prevalence of functional bowel disorders. METHODS: A descriptive cross-sectional study was conducted among 501 Sri Lankan adults (aged 18-80 years) utilizing a hospital attendant-based sample with community representation. Data was collected using a structured interviewer-administered questionnaire incorporating the Bristol Stool Form Scale and ROME-IV diagnostic criteria. RESULTS: The median bowel frequency was seven (IQR 7-14) bowel movements per week, with 56.7% reporting a bowel movement once daily and 25.3% twice daily. Most stools were Bristol type IV. Although 79.8% perceived their bowel habits as regular, 36.1% reported feeling constipated and 28.3% had sought medical attention. Only 12.5% fulfilled both ROME IV and self-reported constipation criteria, while 25.5% met ROME-IV criteria for functional constipation and 15.4% for IBS. There was no significant association between bowel frequency and the feeling of constipation, but straining, hard stools and incomplete evacuation were strongly associated with perceived constipation (p < 0.001). Hydration was a key associated factor: participants with adequate water intake (≥ 2.5 L/day) were more likely to report regular bowel habits (p < 0.001). Frequent use of water-assisted toileting practices was a notable cultural finding. CONCLUSIONS: Sri Lankan adults demonstrate bowel habit patterns similar to other Asian populations, but distinct from western norms. Cultural perceptions and hydration practices strongly influence bowel regularity. These findings underscore the importance of culturally adapted diagnostic frameworks when assessing bowel disorders in South Asian populations.